THE www.thedermdigest.com Vol. 2, No. 5 | May 2021 Delusions of Parasitosis New Drugs Injectable Harnesses Immune Response against CA Devices for Hyperhidrosis Ted Talks Does IKEA Sell Rocking Chairs? Permit No. 129 No. Permit Columbus, WI Columbus, PAID US Postage US Prsrt Mkt Prsrt EDUCATIONAL • INTERACTIVE • AUTHORITATIVE THE Contents www.thedermdigest.com Volume 2, Number 5 | May 2021 2 Ted Talks Does IKEA sell 18 rocking chairs? Cover Article Delusional parasitosis: Artful interactions for dealing with a tricky condition 6 Literature Lessons Research updates in COVID-19, pediatric derma- tology, infectious diseases, atopic dematitis, cutaneous oncology, and more The Dermatology Digest is Different Our multimedia approach delivers engaging and authoritative content in digestible bites for dermatologists overloaded with information in the emerging virtual environment. A distinct new concept, The Dermatology Digest filters practical and important information from industry meetings and develops original content for identified knowledge gaps in digital (video, podcast) and print formats. Concise, yet comprehensive, our content comes from the views, voices, and visions of leading dermatologists. As such, ours is an informative, educational approach that emphasizes key details in support of safe, efficacious patient results. continued on page 3 May 2021 | 1 Ted Talks “ The older I grow, the more I distrust the familiar doctrine that age brings wisdom.” —H. L. Mencken t was a small thing, really. I was in my home study, creating a slideshow to be presented at Ian upcoming meeting. I was designing a table of the various approved agents for the topical treatment of onychomycosis. I had already listed the generic names and was about to include the brand names. To my chagrin and utter frustration, I simply could not recall the trade name of one of the drugs. I looked it up by entering the generic name into my acces- Ted Rosen, MD, FAAD sory brain (Google) and finished my task. But Editor-in-Chief it got me to thinking ... wasn’t it just the prior week that I could not remember the first name This is Ted's take. of a patient I have cared for more than 3 de- What's yours? cades? I could picture her and knew her illness [email protected] and treatment regimen, but I couldn’t remem- ber her first name! I started to worry about later. But dermatologists routinely retire being in mental decline, or worse, early stage 5 years or more after the mean physician dementia. When would I forget how to dose retirement age. So, we traditionally tend to terbinafine? Or maybe forget what terbinafine practice longer into life’s journey. Which even was? Was it my time to research long- brings me to this point: at a certain age, term care facilities and to purchase a comfort- should we all be subject to voluntary—or able rocking chair? even involuntary—periodic cognitive and We all age, and as we do so, some (or all) of physical reassessment? This is much different our capabilities naturally wane and weaken. from taking another iteration of a certifying At what point do our inherent strengths fade board examination or collecting a specified sufficiently for us to conclude our time as number of CME credits annually. What I’m healthcare providers? It has been written in talking about is a comprehensive battery of many corners that physicians, as a group, tests which might measure fine-motor skill, are among the least likely to recognize and motor planning capability, visual acuity and acknowledge their own declining professional pattern recognition, psychomotor efficiency, prowess. Yet it is intuitively obvious that as processing speed under pressure, concentra- professionals dealing with human life, clini- tion, capacity of both long- and short-term cians of all types must possess both the proper memory, interpersonal communication skills, physical and cognitive capacities to safely and executive functioning, among others. By practice medicine. This becomes an especially the way, executive functioning relates to self- pertinent concern for dermatologists. regulation, including foresight and flexibility in executing an organized strategy in response The average age of retirement for American to situational demands. For example, you plan physicians is 65.1 years. Gynecologists retire a cyst excision but the patient arrives to the about a year earlier, cardiologists about a year office complaining of substernal chest pain! continued on page 4 2 | The Dermatology Digest www.thedermdigest.com/TOC Contents continued from page 1 22 45 General Dermatology Cosmetic Corner Literature Update Options for hyperhidrosis: 30 Topical corticosteroids and the A review of old and new techniques risk of osteoporosis, fractures What is the risk of vascular occlusion when injecting fillers? 34 All about eyelashes: Your patients' interest is likely increasing 37 New Drugs 50 Cavrotolimod targets PD-1 inhibitor resistance Diagnose this Zebra Drug-induced bullous pemphigoid with a twist 26 41 Pediatrics Integrative Medicine Primary hyperhidrosis in children: IV therapy addresses energy What we know has changed and other health issues as well as skin aesthetics 52 COVID Concerns Immunosuppression and COVID-19 outcomes: Is there an effect? May 2021 | 3 www.thedermdigest.com/TED_TALKS continued from page 2 THE Taken together, the assessments listed above of 1967). Fourth, objective evidence solidly could determine the ability of a physician to verifying that advancing age predicts or closely reason, interpret, monitor, problem-solve, correlates with poorer clinical outcomes is adapt, and utilize sound medical judgement. scant and somewhat debatable. www.thedermdigest.com As you might expect, this concept is not so Finally, I wonder if the entire proposition far-fetched. In fact, Yale New Haven Hospital, of mandatory cognitive testing for older physi- CORPORATE Intermountain Healthcare, Stanford Hospi- cians doesn’t discount the incredible value AMY AMMON tals and Clinics, Scripps Health Care, Penn of wisdom derived largely from experience. Executive Director, Publisher [email protected] Medicine, and the University of California, I recall a recent case of dyschromia of the back; DON BERMAN San Diego—to name a few—already have my trainees were concerned about macular Executive Director, Digital Strategy [email protected] mandatory assessment programs for clini- amyloid and confluent and reticulated papillo- GEORGE MARTIN, MD cians at and above a certain age. Indeed, it is matosis of Gougerot and Carteaud. In a rather Executive Director entirely realistic to ask: Should such a require- EDITORIAL ment become universal? Needless to say, such TERESA MCNULTY assessment would have to be consistent and I wonder if the entire proposition Print Editor fair, judged against validated normative values of mandatory cognitive testing for ELIZA CABANA reflective of age, and interpreted in terms of Digital Editor relevance to actual clinical duties and respon- older physicians doesn’t discount NANCY BITTEKER Creative Director sibilities. Before limiting or revoking licensure/“the incredible value of wisdom MICHAEL WESTFALL credentials, there must also be a reasonable Product Manager appeal process, perhaps including repeat derived largely from experience.” testing using an alternative methodology. It also would be advisable to include gradations dramatic fashion, I removed a swath of the Print Circulation: of consequence, varying all the way from no pathology by merely rubbing the skin with 13,500 dermatologists USA change in clinical privileges, to a controlled/ an alcohol swab. Having been in practice a 2,800 dermatological NP/PA’s proctored practice, to removal of licensure/ long time, I had encountered terra firma- The Dermatology Digest ® is published monthly by The Dermatology Digest, credentials. To some degree, many of the cur- forme dermatosis before, whereas all my LLC, 88 N Main Street, Pearl River, NY 10965. rent mandatory periodic assessments include younger colleagues—whose fine-motor co- © 2020 The Dermatology Digest, LLC. these qualifying parameters. ordination and short-term memory are most All rights reserved. No part of this pub- lication may be reproduced or trans- Nonetheless, I am somewhat hesitant to likely superior to mine—simply had not. mitted in any form or by any means, electronic or mechanical including by jump on this bandwagon. Of course, we all I don’t question the sincere and well-meaning photocopy, recording, or information storage and retrieval without permis- want to do what’s best for the very people we intention of those advocating for cognitive sion in writing from the publisher. Authorization to photocopy items for serve—our patients. We want them to receive assessment of older physicians. But I’m not so internal/educational or personal use, or the internal/educational or personal the highest quality of care possible from fully sure that the time and money spent on such use of specific clients is granted by The capable physicians. But the assessment of endeavors is entirely worth it, and might not Dermatology Digest, LLC. For uses beyond those listed above, please aging physicians is fraught with many poten- actually cause some degree of harm to the direct your written request to Amy Ammon, Executive Director, Publisher tial difficulties. First, who determines exactly healthcare system. Before we rush into this at: [email protected]. which tests comprise the screening battery? black hole, we need to carefully